By Patricia Jones, Alliance Community Task Force: Creating Opportunity
This summer Congress passed the Inflation Reduction Act. A part of the law makes several changes to Medicare Part D drug benefits.
Starting on Jan. 1, 2023, many more vaccines are free for those on Medicare. Medicare Part B fully covers vaccines for flu, pneumonia, hepatitis B, and COVID. But other vaccines, like shingles, are covered under the Part D prescription drug plans, and how they are covered varies by the insurance company. The plan Earl and I have currently requires a $202 co-pay for each of the two shots in the shingles series. The new law makes shingles and other vaccines free for people with Medicare Part D prescription drug plans if they are recommended by the Centers for Disease Control.
Currently, Medicare beneficiaries with serious health conditions can face catastrophic out-of-pocket prescription drug costs. The new law requires Part D plans to strengthen financial protections that will phase in starting in 2024, with a $2,000 out-of-pocket cap taking effect in 2025.
This limit applies to all prescriptions, including out-of-pocket payments for medicines like insulin. If your Part D plan has a prescription drug deductible, that amount will count toward the $2,000 cap. Beginning in 2023, copays for a 30-day supply of any insulin that a Medicare drug plan covers will be capped at $35. Part D plans will be required to adhere to the $35 copay limit even if an enrollee has not met their annual deductible.
In 2024, the year before the out-of-pocket cap takes effect, Medicare beneficiaries will no longer have any out-of-pocket costs once they enter catastrophic coverage. The way Medicare catastrophic coverage works in 2022 is that once an enrollee’s out-of-pocket costs reach $7,050, they have to pay 5 percent of their remaining prescription drug costs, with no maximum limit. In 2024, once someone hits the $7,050 limit, they won’t have to pay anything for their prescription drugs for the rest of the year.
According to the new law, beginning in 2024 and continuing through 2029, Part D premiums cannot increase by more than 6 percent a year. The amount of these premiums varies widely, depending on where you live and what plan you select. In 2022 the national average Part D premium is $33.37 a month.
Medicare has several parts. Medicare Part A is hospital insurance, and it covers inpatient hospital care, hospice, lab tests, and surgery.
Medical insurance is provided by Medicare Part B. This covers doctor and other health care providers' services to diagnose and treat medical conditions. Part B covers durable medical equipment and many preventive services like vaccinations.
Medicare Advantage plans are called Part C and are provided by private companies in large cities. Medicare supplements are Plans F, G, K, L, and N.
There are still several things Medicare does not cover, including long-term care (nursing homes), most dental care, dentures, exams for prescription eyeglasses and hearing aids. For people not lawfully present in the U.S., Medicare won't provide any coverage.
Millions of senior citizens will get relief thanks to the Inflation Reduction Act, which reduces out-of-control drug prices.